Locoregional recurrence in triple negative breast cancer: past, present, and future

ABSTRACT

Introduction

Triple negative breast cancer (TNBC) is a rare but aggressive biological subtype of breast cancer associated with higher locoregional and distant recurrence rates and lower overall survival despite advancements in diagnostic and treatment strategies.

Areas covered

This review explores the evolving landscape of locoregional recurrence (LRR) in TNBC with improved surgical and radiation therapy delivery techniques including salvage breast conserving surgery (SBCS), re-irradiation, and thermo-radiation. We review current retrospective and prospective, albeit limited, clinical data highlighting the optimal management of locoregionally recurrent TNBC. We also discuss tumor genomic profiling and transcriptome analysis and review potential investigational directions.

Expert opinion

Significant progress has been made in the prevention of LRR but rates remain suboptimal, particularly in the TNBC population, and outcomes following LRR are poor. Further prospective studies are needed to identify the most effective and safest systemic therapy regimens and to whom it should be offered. There has been growing interest in the role of molecular markers, genomic signatures, and tumor microenvironment in predicting outcomes and guiding LRR treatment. Transcriptome analyses and biomarker-driven investigations are currently being studied and represent a promising era of development in the management of LRR.

KEYWORDS:

• Local recurrence
• locoregional recurrence
• regional recurrence
• triple negative breast cancer
• transcriptome analysis

Article highlights

• Distinct molecular mutations and gene expression patterns have been associated including LRR risk and may provide insight into treatment response and clinical outcomes.

• Repeat biopsy and breast cancer markers should be repeated to distinguish between LRR and new breast cancer primary.

• Salvage mastectomy is historically considered standard of care treatment in LRR although SBCS can be considered in select patients.

• Repeat radiation therapy can be offered to select patients in conjunction with surgery or systemic therapy to achieve better outcomes.

• Chemotherapy is likely to be beneficial for TNBC LRR based on the findings of the prospective CALOR trial, though it must be noted CALOR trial only included patients with optimal resection of local recurrence.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript is a member of the MARECA study team. The remaining reviewers have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.